Purpose

Successful outcome after opening wedge high tibial osteotomy (HTO) has been correlated with obtaining and maintaining angular correction while achieving union. Magnitude of correction, type of fixation and use of bone graft have been implicated as variables which can affect maintenance of correction.

The purpose of this study was to determine whether loss of coronal plane correction occurs over time following opening wedge HTO using our standard surgical techniques (unlocked plate with allograft). Our aim was also to correlate clinical outcome measures and radiographic findings. Our hypothesis was that no significant loss of correction would occur.

Purpose: Due to bed and resource constraints at the Royal University Hospital in Saskatoon, Saskatchewan, we have seen an increase in utilization of the day surgery program for acute Orthopedic traumatic injuries in ambulatory patients. The purpose of this study was to assess patient satisfaction with the Saskatoon Health Region Orthopedic trauma day surgery program by collecting data pertaining to wait-times, demographics, communication, coping skills at home and pain management.

Method: A patient-oriented questionnaire was devised and administered to eligible adult patients presenting for day surgery Orthopedic Trauma procedures over a three month period. Inclusion criteria included age greater than 18 and written english comprehension. Between July 12 and October 2, 2009, 45 patients consented to participate. The questionnaire was formulated to encapsulate all the potential concerns associated with the day-surgery program, which included expected wait-times, pain control, and communication between the orthopedic surgeon and the patient. Demographics and actual wait-times were obtained from hospital data.

Results: There was a marked discrepancy between the actual and anticipated waiting times for day surgery. However, 64% of the patients were still satisfied with the waiting times despite the difference. Seventy three percent of patients did not think that admission to hospital would lead to earlier surgery. There was an obvious difference in demographics with 53% of patients living outside city limits. Demographics played an important role in patient satisfaction. Patients living within the city limits had a better experience compared to patients living outside city limits. Patients did have difficulty managing at home. The overall satisfaction was 68% at the conclusion of the study.

Conclusion: Patients were overall satisfied with the day surgery program. We have identified several areas where we can improve. This involve better pain management, better communication and assessment of the bio-socioeconomic circumstances of patients. We will also have a lower threshold for admitting non residents of Saskatoon. We will relay a more realistic timeframe for surgery, as calculated in the study, to patients .

Purpose: Little evidence exists to guide rehabilitation following arthroscopic rotator cuff repair (ARCR). It is unclear how new repair techniques may affect postoperative protocols. Our purpose was to determine current practices of members of the Arthroscopy Association of North America (AANA) and the American Orthopaedic Society for Sports Medicine (AOSSM.) Our hypothesis was that wide variation would exist in the postoperative rehabilitation following ARCR and that accelerated protocols would commonly be prescribed after double row ARCR.

Method: A 28 question web-based survey was sent to all active members of AANA and AOSSM via email addresses listed in the specialty society directory. Non-responders were reminded by 2 additional invitations. Results were tabulated and responses reported as a percentage of respondents.

Results: The response rate was 37.7% (797/2112). Most commonly, respondents use a post-operative abduction sling (56.2%) and begin physical therapy within the first 2 weeks (42.1%.) Passive ROM is initiated within 2 weeks (74.1%), active ROM after 6 weeks (55.3%) and strengthening after 6 weeks (64.4%). Unrestricted activities are permitted at 5 months (41.2%.) 85.2% of respondents alter rehabilitation based upon tear size. Protocols were altered based upon tissue quality (86.9%), involvement of subscapularis (68.7%) or biceps tendon (65.2%) but not for workers compensation status (97.1%), smoking (71.5%) or patient age (70.3%.) 81.1% had performed double row rotator cuff repairs; however 95.2% of those do not alter their postoperative protocol based upon repair configuration.

Conclusion: Our results demonstrate wide variation among respondents with regards to immobilization, ROM and return to activity. The majority had performed double row ARCR, however 95.2% of these do not alter their postoperative rehabilitation in patients undergoing double row repair.

Purpose: To evaluate the insertion forces required to seat osteochondral plug grafts and the accuracy of plug harvest and seating using three unique instrumentation systems. Our hypothesis was that the systems would have different insertion forces.

Method: The COR (Depuy-Mitek), Mosaicplasty (Smith & Nephew) and OATS (Arthrex.) Instrumentation systems and recommended surgical techniques were used to harvest, transfer, and implant grafts. To simulate the in-vivo surgical setting, multiple-impacts with a mallet were applied to the instruments. Ten tests each were performed for all systems in both rigid polyurethane foam blocks and porcine femur models. Plug length after harvest and final graft position were manually measured. Insertion forces were recorded using a load cell (Omega Engineering) affixed to the insertion tamp. The area under the force curve recorded by the transducer for each blow was then summed to yield the total force required to seat each graft. Means and standard deviations were then calculated and Tukey’s test was used to determine significant differences between the means.

Results: The COR system demonstrated significantly lower mean insertion forces in both polyurethane foam blocks and porcine models when compared with the OATS and Mosaicplasty systems. Graft harvest with Mosiacplasty led to greater harvest length inconsistency than with other systems tested. OATS grafts were more likely to be left proud.

Conclusion: The COR system produced significantly lower insertion forces during graft insertion. COR and OATS yielded consistent harvest lengths. The majority of OATS grafts were left proud which would require additional impaction force to fully seat the graft.

Purpose: New high-strength sutures demonstrate high failure loads, but may be more likely to slip compared with polyester sutures. The purpose of this study was to determine the knot security and ultimate failure load of 8 common sutures tied with 6 arthroscopic knots. The hypothesis was that knots tied using high-strength sutures would not slip and demonstrate greater tensile strengths than polyester suture.

Method: Eight different sutures (Ethibond, FiberWire, ForceFiber, Hi-Fi, MagnumWire, Maxbraid, Ortho-cord and Ultrabraid) were tied with 6 arthroscopic knots (Duncan, Revo, San Diego, SMC, Tennessee and Weston.) Knots were backed up with 4 reversed half-hitches on alternating posts. Each suture-knot combination was tied 10 times for a total of 480 knots tested. Cyclic testing was performed followed by loading to failure. Mode of failure, ultimate failure load and force during slippage was recorded.

Results: FiberWire demonstrated the highest failure load (259.70N+/−85.81) and Ethibond the lowest (143.92N+/−16.56) (p< 0.05). Knots tied with Ethibond slipped 22.4% of the time compared with 31.7%–40.0% for high-strength sutures. Frequent slippage occurred with Duncan loops (97.5%) and Weston knots (86.3%) while the SMC (1.3%) and Revo knots (3.6%) rarely slipped (p< 0.05). Mean failure loads were highest for the Revo (280.99N +/− 57.01) and SMC knots (274.89N +/−57.90) compared with all others (p< 0.05).

Conclusion: Our results demonstrate that knots tied with Ethibond were least likely to slip and yielded a more consistent (narrow standard deviation) but overall lower ultimate tensile strength than all of the high strength sutures. Early slippage of some knots tied with high-strength suture was responsible for greater variability with some failing at sub-maximal loads. The Duncan loop and Weston knots were the most likely to slip.